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On 14 Oct 2023, Seniors Today hosted their weekly Health Live Webinar with Dr Rajeev Chinoy and Dr Shubhada Kale who spoke on and answered questions about Arthritis Care for Seniors.
About Dr Rajveer Chinoy
Dr Rajveer Chinoy graduated from the Grant Medical College and did his Orthopaedic training at the J J Hospital and after his MS in Orthopaedics, he went to England in 1983 and worked in various specialised units around the UK for 12 years. Dr Chinoy is currently attached to the Hinduja Hospital, Mumbai.
About Dr Shubhada Kalke
Dr Shubhada Kalke is an MBBS from Seth G S Medical College and KEM Hospital and an MD in Internal Medicine from the Grant Medical College and Sir JJ Group of Hospitals. She has been a Consultant in Rheumatology from 2002 and is currently attached to the Global Hospital and the Shushrusha Hospitals in Mumbai.
Arthritis and Rheumatism are loosely and interchangeably used words. In our colloquial language we also hear patients refer to it as “vaat”- in ayurveda Or “gathia”- rheumatoid arthritis.
Arth means joints and it means inflammation. Therefore, inflammation of the joints is called Arthritis.
Rheumatism includes the soft tissue and ligaments around the joints.
Types of arthritis
- Wear and tear type of arthritis
- Inflammatory arthritis
We will be covering wear and tear type of arthritis which is more common in the elderly patients
Some common problems
- Knee pain
- Back pain
- Neck pain
The knee joint is formed by the femur on top and the tibia and fibula below. There is also the patella which is also called the kneecap. The joint is protected by the joint capsule and inside the joint is the synovial membrane which lubricates the joint which helps in facilitating the movement. The muscles round the joint also undergo contraction to help in the movement.
In the knee joint, there is also the presence of cartilage and meniscus- structs which support weight bearing and play the role of shock absorbers.
As age progresses, due to the wear and tear, the cartilage and menisci are the first to undergo damage. Leading to bone on bone movement.
Signs and symptoms of osteoarthritis:
- Pain- the commonest symptom
- Swelling/ warmth- occasional seen in osteoarthritis
- Stiffness of the joint
- Restriction of movement
Risk factors include
- Progressing Age
- Sex: females are at a higher risk than males
- Genetic predisposition
- Obesity
- Injury/Overuse
- Occupational- long sitting jobs, individuals who lift heavy weights frequently
- Comorbidities
Investigations required for the diagnosis of OA:
- X ray of the knee joint- shows markered joint space reduction
However, Blood investigations are not necessary, they can be done in the elderly before prescribing them certain medications, these investigations can include
- CBC ESR
- Creatinine
- SGPT, S.albumin
- Urine routine culture
- ASO
- Other tests, MRI, Nerve study, osteoporosis
Inflammatory arthritis includes
- RA
- Psoaitic arthritis
- Ankylosing spondylitis
- Post viral arthritis
- Reactive arthritis
- Lupus
- Vasculitis
- Scroderma
- infection
Treatment modalities include:
- Non pharmacolological
- Rest
- Avoid extreme positions
- Support- temporary
- Heat /cold- this is a personal preference. However, if there is an injury, cold fermentation is preferred. And in cases with muscle spasm- heat fomentation is preferred
- Physiotherapy modalities
- Exercises are the most important for mobility, strength and balance
- Reduction in risk factors like obesity
- Pharmacological
- Analgesics- paracetamol, tramadol, muscle relaxants
- Anti-inflammatory- brufen, voveran ( creatinine)
- Local therapy- capsesin, anti inflammatory
- Glucosamine and chondroitin- help in stabilising the cartilage
- Diacerine
- HCQS in inflammatory OA
- Joint injections in the form of- PRP, Hyaluran, steroids
OA of the Hip:
- It is rare
- Increasing due to our sedentary lifestyle and reduced squatting
- More with other forms of arthritis like AS
AVN of the Hip:
- This is due to a cut of of blood supply
- this is commonly associated with Glucocorticoid use, alcohol abuse
- Can also be following an injury
- The treatment involves stoppage the causative factor and Bisphosphonates
Non medical treatments for different kinds of arthritis in different joints
Patient education- about the disease, its progression, how to manage and alleviate the pain adn different management modalities
- Exercises
- Dietary advice- for weight reduction
- Hydrotherapy
- Hyaluronic acid injections- are injected into the joint and help in lubricating the joint and help in cartilage repair.
- They act as a reparative substance and as a lubricative
- It is used in patients with early arthritis
- Weight loss, for overweight patients with knee osteoarthritis
- Surgery:
- High tibial osteotomy- done in the younger, active non- obese patients who have an isolated virus deformity of the knee resulting from medial compartment osteoarthritis.
- This improves the weight bearing axis, and aids mobility.
- Unicondylar knee replacement- done in patients with isolated medial compartment osteoarthritis
- Isolated lateral compartment osteoarthritis
- Isolated patellofemoral osteoarthritis
- Compared to a Total Knee Replacement surgery, it has faster rehabilitation, quicker recovery, less infection and less costlier
- It maintains the normal kinematics of the knee
- Total knee replacement- done in patients with tricompartmental osteoarthritis of the knee
Lifestyle measures play a major role
- Weight loss for overweight patients
- Avoid standing for long periods, long walks and carrying heavy loads during painful episodes (relative rest) – “pacing of activities”. Work within your capacity
- Strengthening exercises between flares and regular aerobic activity
- Use a walking stick on the contralateral side
- Suitable and appropriate footwear with cushioning soles for better shock absorption
In Hip Arthritis the following treatments are done
- Bisphosphonate Therapy
- Hip resurfacing surgery- this was widely used in the olden days, nowadays it is used in younger, active patients
- Bipolar hip replacement
- Dual mobility total hip replacement
- Total hip replacement
Take home message
- Have an active lifestyle
- Weight reduction in patients who are obese or overweight
- Quadriceps strengthening exercises
- Hamstrings strengthening exercises
- Avoid alcohol or any kind of addiction
- Avoid steroids use if possible
